Insights and future directions in studying intestinal microbiota post-transjugular intrahepatic portosystemic shunt for hepatitis B virus-related portal hypertension

Abstract

The gut microbiota (GM) plays a major role in the progression and treatment response of liver diseases, with diverse compositions based on different etiologies. In China, hepatitis B virus (HBV) infection is the leading cause of cirrhosis and affects the GM composition in patients with cirrhosis-related portal hypertension (PH). However, a few studies have been conducted on GM alterations after transjugular intrahepatic portosystemic shunt (TIPS) in patients with HBV-related PH. A recent study investigated the changes in the GM in these patients after TIPS. This study found an increase in potentially pathogenic bacteria and a decrease in beneficial bacteria post-TIPS, particularly in patients with hepatic encephalopathy (HE), indicating the potential role of the GM in HE prediction and management post-TIPS. Nevertheless, the study had several limitations, including a small sample size, limited follow-up, a single time point for sample collection, and inadequate analysis of the correlation between intestinal flora, HBV infection status, and clinical parameters. Future research should address these limitations by expanding the sample size, prolonging the follow-up duration, collecting samples at multiple time points, and conducting comprehensive analyses to confirm the findings and evaluate the effectiveness of individualized microbiome-based therapies.

Keywords: Gut microbiota; Hepatitis B virus; Portal hypertension; Transjugular intrahepatic portosystemic shunt; Hepatic encephalopathy

Core Tip: Hepatitis B virus (HBV) infection promotes cirrhosis in China, causing changes in the gut microbiota (GM) in patients with portal hypertension (PH) GM linked to hepatic encephalopathy (HE). Although a transjugular intrahepatic portosystemic shunt (TIPS) is used to treat PH complications, postoperative HE persists. A recent study explored GM dynamics in patients with HBV-PH post-TIPS and found higher GM synergism in patients without HE than that in those with HE, suggesting it may predict post-TIPS HE risk. However, limitations, such as small sample size, short follow-up, single fecal sampling, and lack of comprehensive analysis of the flora-HBV clinical interplay exist. Future research should prioritize addressing these issues to validate our findings and assess personalized microbiome therapies for post-TIPS HE.